In this revised proposal we plan to design and test a new nursing intervention based on one found to be successful in managing uncertainty in older women with breast cancer who were long term survivors. This study will test a new version of the intervention with Caucasian and African-American younger women under 50 years of age who are 2 through four-year survivors. For these women, during the early years of survival, the situation is more complex and threatening than that of older women who are long term survivors. The intervention will focus on the fears of recurrence and will target the invasive thoughts about recurrence as they are triggered by various life events. The intervention will also focus on the needs of these women to communicate concerns to supportive others and find positive meaning to life events. Furthermore, the intervention will focus on the concerns of women who were pre-menopausal prior to treatment and post menopausal due to treatment. The intervention will include cognitive behavior strategies in the form of two audiotapes illustrating an individual strategy and two new tapes on communicating concerns to supportive others and promoting positive life experiences. A self-learning manual is included which provides information and resources for managing the most common postmenopausal symptoms and altered life experiences of these women. The main hypothesis is that women who receive the uncertainty management intervention will have better uncertainty management, less symptom distress, more positive psycho-social well being with identifiable positive benefits as compared with an attentional control group. The study will also examine the effect of the intervention on biobehavioral mechanisms associated with stress (cortisol levels and diurnal slopes, and cortisol reactivity to a visit to the oncologist for a breast exam). The design is a 2 X 2 randomized block, repeated measures design with two levels of intervention (managing uncertainty) crossed with 2 levels of ethnicity (Caucasian and African-American). Women will be instructed in the use of the cognitive behavior audiotapes and use of the manual for 4 weeks followed by with monthly calls from a nurse to assess exposure to triggers, use of the audiotapes, and use of the manual. The majority of the intervention is self delivered. Multivariate models will be used for analysis. The study is relevant to public health as it is the first intervention that focuses on younger breast cancer survivors and provides them with a self-directed, portable intervention teaching new skills for handling enduring concerns of cancer survivorship. The intervention is portable and can be used in a variety of places. As women learn these skills they can use them on their own and they can become part of their natural management/ coping behavior. [unreadable] [unreadable] [unreadable] [unreadable]